LADMS GP Enhanced Access Service - Louth

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We had not inspected this service before. At this assessment we rated this key question as Good. This meant the service met people’s needs, and that staff treated people equally and without discrimination. This meant people’s needs were met through good organisation and delivery.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The service recognised the diverse population needs and fully understood their service’s demographic and language barriers. For example, translators were utilised to assist with consultations where required.

Accessible standards and barriers to care were considered for people. For example, people who were blind or hard of hearing were collected from the waiting room by the clinicians. A hearing loop was not available at the reception desk or the clinical team. People with autism or a learning disability were offered a quiet place to wait for appointments where available.

The service understood the diverse health and social care needs of the people that used their serviced and tailored its support to meet those needs. This included understanding the needs of people stemming from protected characteristics under the Equality Act and those at most risk of a poorer experience of care.

The service supported and understood the needs of people with learning difficulties and were able to provide a quiet place for them to wait for their appointment. The building had wheelchair access and parking for prams and pushchairs.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service had access to interpreter and translation services, including British Sign Language. Information about the need to book for an interpreter was recorded on people’s records and additional time was provided for appointments. Staff told us they had access to services for translating documents into appropriate languages, including into English.

A range of information on aspect of health for all ages and local support groups were available in the practice, to include weight management, exercise and diet support groups.

We saw notice boards within the waiting room which communicated information for people. For example, carers and young carers, anxiety support group and talking therapies services.

Staff informed us that communication had significantly improved since the new management team had been appointed and leaders were happy to support with any concerns or clinical problems.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result. Staff treated people with compassion and understanding.

We saw complaints were managed in line with the service’s policy. Complaints reviewed showed the practice responded to feedback appropriately, openly and in a non-defensive manner. We found little evidence that learning regarding complaints and significant events was shared with staff. We reviewed one complaint where a person complained about a medication which had been issued. The outcome of the investigation resulted in medication audits being undertaken to ensure that medications issued by the persons regular doctor are not changed where possible. We found that medication audits were not being regularly completed by leaders. We were told that this was due to staff sickness.

The service made sure that people could access the care, support and treatment they needed when they needed it.

The person’s own GP practice booked people into the LADMS enhanced hours service. The GP practice booked people into appointments that were appropriate for their assessed need. For example, for a minor illness the person would be booked with an advanced nurse practitioner, and more complex problems were booked with a doctor. LADMS were able to access the person’s shared medical record, providing the person had provided their consent.

LADMS were able to onward refer people to an alternative service, for example the urgent care centre or hospital consultants for non-urgent services. Administrative staff were also able to signpost people to alternative services. For example, social prescribers and health and wellbeing coaches.

The extended hours provider did not dispense medicines. Louth hospital has a pharmacy to dispense medications. However, the pharmacy is not open during the enhanced access clinic times, therefore, people were issued with a prescription token to take to a pharmacy of their choice, or their prescription was sent electronically to the persons preferred pharmacy. However, local pharmacies were often not open during the evenings and weekends meaning people had to wait for their medicines to be dispensed. Or if people needed the medication urgently they had to travel to other towns to find an open pharmacy to dispense their medicines.

Feedback from people using the service was varied. People told us they worked long hours and found the extended hours service to be their only practical way of accessing GP services. They said they especially benefitted from the provision of weekend appointments. People told us that they felt involved in assessments of their needs and felt confident that staff understood their individual needs. One person told us that they often had to wait several weeks for an appointment with the service to be available to book into.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff treated people equally and without discrimination. Leaders proactively sought ways to address any barriers to improving people’s experience. Staff understood the importance of providing an inclusive approach to care and made adjustments to support equity in people’s experience and outcomes.

Where people’s needs could not be met by the service, staff redirected them to the appropriate service for their needs. For example, the urgent treatment centre.

Referrals and transfers to other services were undertaken in a timely way. LADMS had identified the need for an administrator to liaise with other health care providers, including secondary care, during the normal working hours, and not during the time the extended hours were operating.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

The service carried out regular audits of consultation data to ensure that consent had been recorded within the medical record. However, the service was unable to provide us with evidence of clinical oversight when we initially requested the information. Audits and evidence were shared with us following our assessment.

We were assured that safeguards were in place to ensure that decisions were made which were in the persons’ best interest. When people did not have mental capacity to make their own decisions regarding end-of-life care and priorities for care and treatment. family members and carers were involved in decision making.

The service had robust systems and processes to gather and record consent within the person’s medical record.